The URL can be used to link to this page

08050111CITYIhLCjJPERT1N0'b - IONN BU11MMVISION PERMIT;ICON'TRA ftj�J-NFORMMg Buaq�r �oTMUBB RD PLATINUM ROOFING INC PERMITNO. 08050111 'FIT'S NAME : :PERhffI �TIEDATE RADFORD FINANCIAL 1900 DOBBIN DR 05/13/2008 PHONE: SANITARY NO. CONTROL NO. (408)280-5028 ARCHTTECTIENGINEER: BUILDING PERMIT INFO - BLDGELER PLUMB MECH = l� 0 LICENSED CONfRW(7MES DECLARATION JOU Description busby WTIM that 1 w lived under proviLons of ChaPmr 9 (commencing with Sax:dm7O0) of Divishm3of WC Business and Professions Code, and my license u RE–RF T/0 EXTNG RFS& INSTL 4–PLY BLTUP in full rata and effort uaveclm [— Lk.L CAPSHT,"COOL CAPSHT"CLS A 200SQ Da¢ Comsactar ARS DELLA A N "I W uT I uhMeruanJ my plans aIW M1e used u public rerord Monaco PmfnYanal OWNER -BUILDER DECLARATION 1 hcrtby .ift. m.,1 am Wempt from the Contractors u... Lsw for the follnwing mason. (Sado. RD 1.5, Business and Promaafons Cock: Any city or county which mmu oar, a pmmit to construct, Wer. improve. dem ish, or mpnir my svuatum ! Frim W its hone. shad squirts the applicant forsuch pmmit to Ek a signed ststomWt that nc u uanaed pursuant 10 the provisions df the Contractors license Law (ChaPtm9 Sq. Ft. Floor Area Valuation I (eommenciin[with Scedon7000) of Division 3ofNeBusihwssand ProfasionsCoot) or $157562 . that he is e.mpt tkmfrom and the buts for the alleged gas mp0on Any violation of 3 5 7 2 0 0 3 8 EbT Number Occupancy Type Sossion 703IJve mIt dbxmnapplicant m a civil wwlr ormassfmboaddo�( ❑ I. u owner of tK property, m mY emPlaYm wIN wag. ss tlm'v sole compewton, Required Inspections will do the wank and the structum u natinuMW mo@red tarok (Su:. TOa4, Busimss = and ProfntiOns cook, The Contractors n Law fuant apply to an awner or p.pywho Wilamimproveathumn,andwMo swhw khimsrlforW aghhis rst awn cmplaym, provided Nu such imVronmmts sm notinu:ndeo oro@sd formic. B. however. the building m improwmhant I. sold within ane year of cornylotion, the owner - Wilder will haw the When of proving out In did not build or imprvn fm purpos of .k.). ❑ 1, as owner of the property am uelusinhy contracting with Ilcenmd contractors to construct the project (Sec. 1044. Busitm and Profmadons Code:) The Coouxtm's li sue law dm not apply to m sura of property wish Wilds car improvo Nemo.. and who contracts for such projects with a contracmr(s) lived pursmnt to the Contractors License law. ❑I..mhptundo Bee .BkPCfm NisrWsaa m Das WORKER -S COMPENSATION DECLARATION I nereby alarm under po salty of perjury one of the following dclarWahsc ❑ 1 M1aw aM will maintsin a Cenifiwmaf Covent to sl(insam (or markers Compw- .tion, as provided for by Section 3100 of the IaWr Cade. fm the peRorohana of the work for which Nis pont is issued. ❑ 1 ban arho will mumu. Workers Compensation inouana, as hop had by Section 3700.(Jan labor Cook. for Ne performaneeofdm work fnwhich this permit is issued. ' My Worim ompeuaJon Wuramec�amrieay1Iatd Policynntunberare: /r�� (� Carrion . (�d>r) a i�, fNsllPOhiry No.: X13 -' M / >R10 ) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tbif sctitm ted rotbecornpkmd if the permit is forone handmt da0an ($100) orlon) 1 artily that in me porformanee of the work for which this permit is issues. I shall not employ any Peron in my manner. as N become subject to the Wmkma' Compensation taws of California. Dam Applicant NOTICE TO APPLICAND If, after making this Cenificam of Exemption, you should become subject to Ne Workers Com,mosm. provisions of the labor Cod, you moa • foMwith comply with such provisions or Nu permit shin be d crrcd rooked. j CONSTRUCTION LENDING AGENCY . IMroby iaand(S 3M,Chgg agumy for tan perfmmamm of Nalot which mu the work ran which Nis pemhil k iumL (sue, 709'1, Civ. C) I .. Lends Name Lcndeh Addrm j 1 artily that 1 have mad this application W sum thu the Shan information is ' camel I aye to comply with all city and county on inures and auto dews misting to Wilding construction, and beteby a oOmm, repmxnutins of this city to w.,n the shave -menton. property for inspection purFass. (Wk,) agora to on, indemnify and kap harmless the City of Cupertino agunst j Iisbilitin.jWgmenu.cmts andexpevn which may in anyway acmay e ina wdCity of Nu permit. of the UNDERSTANDS A APPLICANT APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued b Date REGULATIONS(;--/ y Type of Roof 3 -0� 0"oZ'rRe-roofs Signaturso(ApplicanuoZontracaor Dam HAZARDOUS MATERIALSDISCLOSURE Will theapplicant orfolum Wildingmcupantr9Aorand ha'ssNoumamriu pa def the vo Municipal Code. chapter 9.13. and Um HnIN and Safety - Sec Section 32(.)7 . xenon ass3x(.)1 ❑ Yn )7No All roofs shall be inspected prior to any roofing material being installed. ii , Will If a roof is installed without first obtainingan inspection, I agree to remove Pe g the aPp onto i amort Wilding by ft Bt ase a Air Qu car Mxm whim emit W'raNnu air contaminants u de0ncd by Um Bay Ama Air Quality Management all new materials for inspection. Disuictl ❑Yrs rXWd - lhavo mad tm lumarchou``materials mquimmem under Chapmr 6.95 of the Califon. ni-N.i"Safety Code.Sd..2505,25333.d25534. ImWcremnd thmifum building man not Connally ban a man� u ndwt it my mapomibility N nosily the fy aCcupml of On \a�� a e./ requirement which most WCmtfua r rvuarce ofa maf Occvpumy. Signature of Applicant Date s S_ 0 g All roof coverings to be Class 'W' or better owne wn a>masem _ Dam 0 2 ITEMS OF 2 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot:- .' APN ........: 35720038.00 DATE ISSUED.......: 05/13/2008 RECEIPT #.........: BS000004762 REFERENCE ID # ...: 08050111 SITE ADDRESS .....: 10420 BUBB RD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: BRADFORD FINANCIAL ADDRESS ..........: P 0 BOX 117010 CITY/STATE/ZIP ...: BURLINGAME CA, 94010 RECEIVED FROM ....: PLATINUM ROOFING IN CONTRACTOR .......: MICHAEL T. STEPHENSON LIC # 22805 COMPANY ..........: PLATINUM ROOFING INC ADDRESS ..........: 1900 DOBBIN DR CITY/STATE/ZIP ...: SAN JOSE, CA 95133 • TELEPHONE ........: (408.)280-5028 FEE ID UNIT QUANTITY -- ------------- AMOUNT PD -TO -DT THIS REC NEW BAL 1BSEISMICO ---------- VALUATION 157,562.00 ---------------------------------------- 33.18 0.00 33.18 0.00 1REROOFCOM SQUARES 200.00 1255.00 0.00 1255.00 0.00 TOTAL PERMIT ------- ---- --------- ---------- 1288.18 0.00 1288.18 0.00 METHOD OF PAYMENT AMOUNT ---------- REFERENCE NUMBER CHECK --------------- 1,288.18 -------------------- #20838 TOTAL --------------- RECEIPT 1,288.18 VOICE -------- ID DESCRIPTION ---------------------------- VOICE ID DESCRIPTION 601 ROOF TEAR OFF -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF • i Q 1-11— OCA � /L. Plan Review Process Work Book Page -12-Revised 3/25/08 Green Building Plan Check Index of Green Building Points/Categories A. Category Example of an Index or Table of Green Plan Sheet or Page Points Building Points Categories that must be shown and referenced on the Project Plans See below B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 11. Permeable Paving,Note L-1 C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 72points D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 5. Use Truss with heels, (detail) S-2 6. B. OSB Sheathing,detail S-2 E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points 4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points 5. Tankless W.H., (Note/Spec.) A-2 2 points 11. A 2500 Gal. Tank, (Note/Spec L-1 10 points G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point 3. Energy Star Refrigerator, (Note/Spec. A-3 1 point P. Other 1. List Green Features on Plans A•1 1 point MrAMMOM TOTAL POINTS1 40 points • i Q 1-11— OCA � /L. Plan Review Process Work Book Page -12-Revised 3/25/08 • Green Points Rating System for Remodeling Projects Due to the diversity of remodeling project types, assigning a'total points' value to a project to be considered environmentally friendly is not feasible. However, 25 measures have been highlighted to signify that every effort should be made to incorporate them into your projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with ease of implementation and relative low cost. These measures can be used as a starting point for 'greening' your project. I1. Recycle Job Site Construction & Demolition Waste 4 65%=1 point; 75%= 2 points; BO%, = 4 points up to 4 Resource pts . 2. Salvage Reusable Building Materials } 4 Resource is P y --yes _ 3. Remodel for Mixed Use, Adaptive Reuse, and 2 Use FSC Certified Wood for framing Historic Preservation 4 Resource pts y --yes 4. Protect Native Soil 2 Resource pts y --yes 5. Minimize Disruption of Existing Plants & Trees 1 Resource pt y=yes 6. Implement Construction Site Stormwaler Practices 2 Resource pts y=yes 7. Protect Water Quality with Landscape Design 2 Resource pts y=yes r8. Design Resource Efficient Landscapes and Gardens 4 Resource pts y --yes 9. Reuse Matedals/Use Recycled Content Materials 2 Resource pts y --yes for Landscape Areas 2 Resource pts y==yes , 10. Install High -Efficiency Irrigation Systems 2 Resource pts y=yes 11. Provide for On -Site Water Catchment / Retention 2 Resource ots v=ves B.Foundation • 1. Incorporate Recycled Flyash in Concrete 25% Recycled Flyash = 2 points; Add 1 point for every 10%, increase of flyash, up to 5 points up to 5 Resource pts 2. Use Recycled Content Aggregate 2 Resource pts y --yes 3. Insulate Foundation/Slab before backfill 3 Energy pts y=yes C. Structural Frame 1. Substitute S01id Sawn Lumber with Engineered LumberJ 3 Resource pts y=ya` 2 Use FSC Certified Wood for framing (For every 10%, of FSC lumber used = 2 points, up to 10) up to 10 Resource pts. 3. Use Wood I -Joists for Floors and Ceilings 2 Resource pts y_ -yes 4. Use Web Floor Trusses 2 Resource pts y=yes 5. Design Energy Heels on Trusses 6' or more 2 Energy pts y=yes 6. Use Finger -Jointed Studs for Vertical Applications 2 Resource pts y=yes 7. Use Engineered Studs for Vertical Applications 2 Resource pts y=yes B. Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y --yes 9. Use Structural Insulated Panels (SIPS) a. Floors 3 Energy pts y=yes b. Wall 3 Energy pts y=yes c. Roof 3 Energy pts y=yes 10. Apply Advanced Framing Techniques 4 Resource pts y=yes, 11. Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 12. Use 0SB • a. Subfloors 1 Resource pt y=yes b. Sheathing -.. ,_— -------__-- _ --.--- 1Resource pt y=Yes 11. Use Sustainable Decking Materials I a. Recycled content �b. FSC Certified Wood 2. Use Treated Wood That Does Not Contain Chromiurn/Arsenic 13. Install House Wrap under Siding 1 14. Use Fiber -Cement Siding Materials E. Plumbing 1. Install Water Heater Jacket —! 2. Insulate Hot and Cold Water Pipes (3. Retrofit all Faucets and Sliowerhea'ds with Flow Reducers a. Faucets (1 point each, up to 2 points) b. Showerheads (1 point each, up to 2 points) 4. Replace Toilest with Ultra -Low Flush Toilets (1 point each, up to 3 points) — �J s: instar cmonne rarer on �,nowemeao 6. Coned Gas to Tankless Water Heater 7. Install Water Filtration Units at Faucets (2 points each, up to 4 points) 8. Install On -Demand Hot Water Circulation Pump r. trecrncar 1. Install Compact Fluorescent Light Bulbs (CFLs) (6 bulbs=2 points, 10 bulbs 4 points, 12 bulbs = 4 points) 2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to 5 points) 3. Install Lighting Controls (1 point per fixture, up to 4 points) 4. Install High Efficiency Ceiling Fans with CFLs (1 point each, up to 4 points) G. Appliances 1. Install Energy Star Dishwasher 2. Install Washing Machine with Water and Energy Conservation Features 3.lnstall Energy Star Refrigerator 4. Install Built -In Recycling Center H. Insulation 1. Upgrade Insulation to Exceed Title 24 Requirements a. Walls b. Ceilings 2. Install Floor Insulation over Crawl Space 3. Install Recycled -Content, Fiberglass Insulation wi6 No Added Formaldehyde _ 4. Use Advanced Infiltration Reduction Practices 5. Use Cellulose Insulation a. Walls b. Ceilings 6. Alternative Insulation Products (Cotton, spray -foam) a. Walls D. Cemngs 3 Resource pts 3 Resource pts 1 IAQ/Health pt 1 IAO/Health pt 1 Resource of 1 Energy pt Y --Yee 2 Energy pts y=yes Up to 2 Resource pts Up to 2 Resource pts Up to 3 Resource pts 1 IAQ/Health pt y=ye; 4 Energy pts y=ye: Up to 4 IAQ/Health pts 4 Resource pts y=ye< Up to 4 Energy pts. Up to 5 Energy pis. Up to 4 Energy pts. Up to 4 Energy pts, 1 Energy pt 1 Energy pt y=yes 1 Energy pt y=yes 3 Resource pts y=yes 2 Energy pts 2 Energy pts 4 Energy pts 31AQ/Health pts 2 Energy pts r r r � r r r � r 0 M1111 1 Energy pt y=yes 1 Energy pt y=yes 3 Resource pts y=yes 2 Energy pts 2 Energy pts 4 Energy pts 31AQ/Health pts 2 Energy pts 4Resource pts y=yes 4 Resource pts y=yes 4 Resource pts 4 Resource pts 110 • E r r M1111 4Resource pts y=yes 4 Resource pts y=yes 4 Resource pts 4 Resource pts 110 • E t. Install Energy -Efficient Windows i y=yes 10 Energy pts a. Double -Paned 1 Energy pt y=yes b. Low -Emissivity (Low -E) 2 Energy pts y=yes c. Low. Conductivity Frames 2 Energy pts y=yes _ 2. Install Low Heat Transmission Glazing 1 Energy pt y=yes J. Heating Ventilation and Air Conditioning �1. Use l)uctMasfic on All Duct Joints 2. Install Ductwork within Conditioned Space 3. Vent Range Hood to the Outside 4. Clean all Ducts Before Occupancy 5. Install Solar Attic Fan 6. Install Attic Ventilation Systems 7. Install Whole House Fan B. Install Sealed Combustion Units a. Furnaces b. Water Heaters 9. Replace Wall -Mounted Electric and Gas Heaters with Through -the -Wall Heal Pumps 10, Install 13 SEER/11 EER or higher AC with a TXV 11, Install AC with Non -HCFC Refrigerants 12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace • 13. Retrofit Wood Burning Fireplaces a. Install EPA certified wood stoveslnserts b. Instal /Replace Dampers c. Install Airtight Doors 14. Install Zoned, Hydronic Radiant Heating 15. Install High Efficiency Filter 16. Install.Heat Recovery Ventilation Unit (HRV) 17. Install Separate Garage Exhaust Fan - &14newable Energy and Roofing 1. Pre -Plumb for Solar Water Heating 2. Install Solar Water Heating System 3. Pre -Wire for Future Photovoltaic (PV) Installation 4. Install Photovoltaic (PV) System (1.2 kw = 6 points, 2.4 kw = 12 points, 3.6 kw =18 points) .6. Select Safe and�Duratile Roofng Walerials 7. Install RadlaM-Barrer - L. Natural Heating and Cooling 1. Incorporate Passive Solar Heating 2. Install Overhangs or Awnings over South Facing Windows 3. Plant Deciduous Trees on the West and South Sides 0 2 Energy pts 3 Energy pts 1 IAO/Hsalth pt 21AQ/Health pts 2 Energy pts 1 Energy pt 4 Energy pts 31AQ/Health pts 3lAQlHealth pts 3 Energy pts 3 Energy pts 2 Resource pts 2 Energy pts 1 IAQ/Health pt 1 Energy of 1 Energy pt 3 Energy pts 41AQ/Health pts 5 IAQ/Health pts 31AQ/Hseth cis 4 Energy pts y=yes 10 Energy pts y=yes 4 Energy pts y=yes Up to 16 Energy 1 Resource pt y= 3 Energy pts y= 5 Energy pts 3 Energy pts 3 Energy pts y=yes j1. Use Low/No-VOC Paint - __ I IAQ/Health pts y --yes 2. Use Low VOC, Water -Based Woad Finishes 2 IAWealth pts y --yes r'— �3. Use LowMc VOC Adhesives 3 IAQ/Health pts y=yes 4. Use Sa vaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde 6IA0/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7 Seal all Exposed Particleboard or MDF 4 IAQ/Health. L - is — -- — — P Y=Yes 6. Use FSC Cefir"led Mate als for Inte or Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health ots v=ves 8 Resource pts y=yes 2. Use Rapidly Aenewable Flooring Materials ! 4 Resource pts + ` 3. Use Recycled Content Ceramic Tiles 0 D 0 y=yes p 0 0 0 D D------- 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 5. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes n N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Aenewable Flooring Materials ! 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place o1 Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 5. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Aval able: 1 1401 1301 57 • Total Points Project R 1 01 01 0 G:dataiprogs/gmenbuildngguidefineshemodelersigreenpointsfina1212.04pnnetled.ds J IM 1 �J SEQ- CITY OF CUPERTINO ,REROOF CITY OF •CUPERTINO PERMIT APPLICATION APN # 36 Ta 69 03e?. 0 Date: Building Address: !amu Owner's Name: Phon #: (6,s-OJ 3�1 GYOAJI�VAJ DSC ovp 94L(\ Contractor: �`0.jKNr-,tj✓,^� �o� n9 Sn c , Phone #: �Vo g - 2X (D –so F 006 Oob b A Aq-,ve sco) -ase CON Q5-! 3J ' Fax #: y0 g Cupertino Business License #: Contractor License #: 22 X 90/3j Type of Roof Covering: Existing: Proposed: Built-Up Roof A Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles o Other (Specify) ❑ Other (Specify) o� + Number of existing coverings & ❑ Provide I.C.B.O. Report # To d ❑ To be Removed p,11 ❑ Provide Mfgr. Installation Specs. c&— F ,e Job Description: --eAv, - oFr- e_?c,-A;nc,S mors ons ; nS �� 0. Cba,,( PLS Q 0%kV- UP Cap S4ce4 'Cool cap Sled 1// 0&4� Residential 171 Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the there are any restrictions: ❑ application or if applicable, include in plan set & the sheet index. Valuation: /s 7-Z s-62 • I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: SoSE? (77Pc-tn Signature CITY OF CUPEkTINO CITY OF CUPERTINO REROOF FEESCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type qzo 5625 1 REROOFCOM Re -roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 1REROOFRES Re -roof Residential B 1SFDWLROOF 1BSEISMICRE Seismic Residential B IREROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B • Community Development Department Building Division City of Cupertino • 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building Department Subject: Re -roofing policy for the City of Cupertino 1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards and manufacturers specifications on re -roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re -roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre -inspection and/or tear off approval. 2) In -progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re -inspection fee of $176.18. The re -inspection fee must be paid before another inspection can be scheduled IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. Homeowner's Name: J� 11.01 Gn J C! MnU G I P n G ox /13'0/0 AX11 iI)J e Job Site Address: /0'120 11A,Ih 4�. Roofing Company Name: J C& L A 1J rA V -o t1 Applicant's Signature: OSP Date: • Greg Casteel Building Official Revised 11/2/04 0 0 CITY OF UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # / 01 i�r� r OWNER'S NAME: i PHONE t,,5-0) 3L1 .-QD GENERAL CONTRACTOR: r1 FAX # I am not using any subcontractors: -Ib-s :� cC-" Signature Date Please check applicable subcontractors and complete the following information: -To-se- D --e 1k Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing ja ✓nn /1 / Septic Tank Sheet Metal Sheet Rock Tile -To-se- D --e 1k Owner/ Contractor Signature Date